Provider Demographics
NPI:1760764161
Name:SHAW, COLLEEN CRYSTAL (CNP)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:CRYSTAL
Last Name:SHAW
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2947 WELLESLEY DR
Mailing Address - Street 2:
Mailing Address - City:UPPER ARLINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43221-2937
Mailing Address - Country:US
Mailing Address - Phone:614-499-0418
Mailing Address - Fax:
Practice Address - Street 1:1495 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43212-2403
Practice Address - Country:US
Practice Address - Phone:614-499-0418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-13
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12644-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily